This application requests a five-year renewal of our project entitled "The Quality of Life of Older Adult Long-term Cancer Survivors" (R01-CA78975), originally funded as a five-year, longitudinal study. The primary aim is to determine the long-term (5 or more years post-treatment) physiological, psychological, social, and spiritual effects of surviving cancer on older adults (age 60+). This competing renewal responds to the NIA's (Yancik at al., 2001) and the NCI's (Meadows et al., 1998) reports that call for long-term follow-up of older cancer survivors. A comprehensive cancer survivorship model focusing on quality of life (QOL) is framed in the stress and coping perspective. Physical health QOL outcomes include health appraisal, physical and cognitive functioning, and disability burden. Important aims are to distinguish the effects of cancer and its treatment from those of other co-morbid health problems and to document trajectories in health effects and their causes. Psychological outcomes include psychological distress (e.g., anxiety and depression), PTSD symptoms, cancer-related health worries, life satisfaction, and post-traumatic growth. Social outcomes include identity relevant characteristics such as self-esteem, body image, survivor identity, and the ability to maintain valued roles and activities. Spiritual outcomes include religious and spiritual activities and life purpose. The model includes ameliorative resources such as coping style, health beliefs, health promotion, and marshalling health care support. The proposed renewal study will include 320 survivors who have been treated at the Ireland Cancer Center of University Hospitals Health System of Cleveland, an NIH Clinical Cancer Center. The sample will continue to be stratified to include survivors of the most common survivable cancers among older adults, colorectal, prostate, and breast cancers, allowing for the examination of gender differences in the context of gender common and gender specific cancers. African-Americans will continue to be over-sampled to provide the analytic power to identify racial differences in response to cancer. In addition to three annual waves of interviews, event response interviews will document the effects of significant health/illness changes or personal/social losses that occur between annual interviews and identify the transitory/episodic effects of these changes. Analysis will include multivariate analysis such as regression, structural equation modeling, and growth curve analysis. Specific comparative analyses are planned with age, gender, racial, and cancer type subgroups.